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Jensen, Gwenneth Anne. "Outcomes of heart failure discharge instructions." Diss., University of Iowa, 2011. https://ir.uiowa.edu/etd/3318.
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Acute decompensation of chronic heart failure is common and results in many patients being re-hospitalized every year (Jancin 2008). One of four voluntary core measures deployed by the Joint Commission for evaluation of quality of heart failure care in hospitals is heart failure discharge instructions, also called core measure HF1. Although the core measure is a widely disseminated standardized measure related to discharge education, there is little evidence about its impact on patient or readmission outcomes. The purpose of this study was to determine the relationship between the completion of heart failure discharge instructions as defined by the Joint Commission core measure HF1 in a single site, 500 bed tertiary hospital population in the Upper Midwest and the primary endpoint of subsequent readmission to the hospital 30, 90, 180 and 365 days following an index discharge for primary diagnosis of heart failure. Secondary endpoints included hospital readmission charges and total hospital readmission days per year. Patient characteristics, clinical characteristics, unit factors and index visit utilization variables were controlled. This study also described the relationship between nursing unit factors and completion of HF1.
A retrospective, descriptive design, and analyses using primarily generalized linear models, were used to study the relationship of HF1 to utilization outcomes (readmission, hospital days and cost) and unit context (discharge unit and number of inter-unit transfers). Individual level retrospective demographic, clinical, administrative and performance improvement data were used (n = 1034). Results suggested a weak and non-significant association of completion of the core measure HF1 bundle and readmission within 30 days for all cause readmissions (p = .22; OR 1.32), and no association with HF to HF readmissions at 30 days. There was an inverse association
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after 6 months for all cause readmission, and after 90 days for HF to HF readmission. There was a non-significant trend toward a relationship to total hospital days, but no relationship of HF1 to total annual charges. The study did find a significant relationship between type of discharge nursing unit and HF1 completion, and type of discharge unit and readmission. The discharge nursing unit was quite consistently and strongly related to all cause readmissions in binary (p = .029: OR 1.58) and counts analyses (p = .001; OR 1.52), but was not related to the subset of HF to HF readmissions. The study concludes that there is limited relationship between HF1 and 30 day all cause hospital readmission and total readmission days, but a stronger relationship between HF1 and discharge from a cardiology specialty unit. There was also a relationship between cardiology discharge unit and reduction in all cause readmissions.
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First-Williams, Julie. "Educating Staff Nurses for Successful Patient Discharge." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7473.
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The definition of a successful discharge is a discharge that results in patients successfully managing a chronic disease for at least 30 days without requiring an acute inpatient hospitalization. Many chronic disease readmissions are preventable. Successful discharge planning takes a multidisciplinary team that includes nurses who assess the discharge plan and provide additional education where needed. The purpose of this project was to determine staff nurses' understanding of their role in discharge education. Dorothea Orem's self-care deficit theory guided the project and root cause analysis was used in the development of the problem statements. Staff nurses (n=12) from evening and day shift of a rural hospital were interviewed using questions developed from the content from the literature review. Individual interviews were conducted with the volunteer participants and data from the interviews were examined using content analysis. Results included barriers to discharge education were related to inadequate nursing education, poor patient compliance, and inadequate discharge planning. Recommendations from the nurses' interviewed included the need for staff nurse education regarding their role in the educational needs of the patient and their family prior to discharge. The findings from this project may benefit nurses' practice by providing them with an understanding of the need for effective discharge education for patients. When patients are appropriately educated prior to discharge, their ability to self-manage their disease may improve, which can result in a decrease in health care costs and preventable readmissions. Educating nurses about their role in discharge planning promotes positive social change by improving the quality of the discharge education and patient outcomes.
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Walters, Veronica Jeanne. "Geriatric Patient Satisfaction with Discharge Medication Information." University of Toledo Health Science Campus / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=mco1149002272.
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Knott, T. Christine. "Patient admission characteristics influencing discharge destinations from a Geriatric Medicine In-Patient Unit." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq20658.pdf.
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Smith, Cheryl. "Patients’ Perceptions of Patient-Centered Care and the Hospital Experience Pre- and Post-Discharge." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etd/3388.
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Florence Nightingale used the principles of patient-centered care as the foundation for nursing practice. Today, patient-centered care delivery is part of the healthcare reform process that extends interprofessionally throughout all settings of healthcare in the United States (U.S.). Patient satisfaction measurement is one primary determinant of effective patient-centered care. The standardized Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and methods is a nation-wide tool used to measure patient satisfaction. However, this method of patient satisfaction assessment relies on recollections of patients’ hospital experiences and requires accurate memory and recall. This study sought to examine the effect of the memory-experience gap on patients’ perceptions of their hospital experiences and address this research question: Are there any statistical differences between in-hospital and two-week post-discharge perceptions of patient-centered care as measured with HCAHPS patient satisfaction ratings on (a) the composite scores for communication with nurses, communication with physicians, communication about medicines, pain management, staff responsiveness, (b) the individual scores for the hospital environment’s cleanliness and quietness, and the inclusion of patient and family preferences in the plan of care, and (c) the overall global rating score? The design was a non-experimental, prospective, descriptive correlational study. The setting was a 255-bed regional hospital that serves individuals from eight surrounding rural counties in southern middle Tennessee. The case-mix contained diverse individuals with multiple economic, environmental, physical, social and spiritual dynamics. A convenience sample of 82 adult patients ages 26 - 93 represented mainly Caucasian females with mostly cardiovascular and respiratory illnesses who had a minimum one-day stay.
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Jeter, Shelia Celeste. "Destination Arrival and Discharge Unit to Improve Patient Flow." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7933.
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The increase in patients presenting to the emergency department (ED) for primary care poses a serious safety issue in the care that can be provided. In a care area that is overcrowded, physicians, nurses, ancillary department staff, and other care team members may have a difficult time delivering care. Poorly managed flow in the ED leads to overcrowding, and patients with life-threatening illnesses are less likely to be transitioned to designated specialized areas in a safe and efficient manner. The practice-focused question was whether processes to improve the flow of patients entering the ED decreased the number of patients leaving without being seen, decreased time from the time entering the ED to hospital admission, improved the average length of stay, and increased patient satisfaction. The plan-do-check-act methodology was used to address this quality improvement project. Results of the project demonstrated a decrease in the number of patients leaving without being seen, a decrease in the time entering the ED to hospital admission, a decrease in average length of stay, and an increase in patient satisfaction. This project provided positive social change to the patients, families, organization, and community by improving the ED processes to ensure patient needs were addressed as rapidly as possible.
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Ballester, Nicholas A. "Engineering Inpatient Discharges: Disposition Prediction and Day-of-Discharge Planning." Wright State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=wright1509728298874385.
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Adnan, Mehnaz. "A semantic annotation framework for patient-friendly electronic discharge summaries." Thesis, University of Auckland, 2011. http://hdl.handle.net/2292/10272.
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Discharge summaries are intended to include information necessary to communicate the post-discharge framework of care to care providers as well as patients and their families. An important aspect is the availability of easily understandable discharge information to empower patients as partners in their post-discharge care. However, these summaries are found to impose comprehension barriers for consumers. We explore semantic annotation as an approach to improve discharge summaries by assigning links of various semantic types to entities in the text. Our approach is grounded in automated text analysis and panel assessment of a corpus of 200 Electronic Discharge Summaries (EDSs) to identify the barriers to patient use of these summaries. These analyses identified the presence of advanced clinical vocabulary, abbreviations and inadequate patient advice as major obstacles. In response to the findings from corpus analyses, we implemented two components, SemLink and SemAssist. Both of these components use the Unified Medical Language System (UMLS) and the Open Access Collaboratives' Consumer Health Vocabulary (CHV) as biomedical vocabularies and the General Architecture for Text Engineering (GATE) as a natural language processing framework. SemLink is designed to provide readability support for EDS text by adding hyperlinks to the most appropriate and readable consumer-based web resource for difficult terms and phrases. SemLink was developed iteratively and can embed its results in portable document format (PDF). In a preliminary automated evaluation, SemLink achieved 95% precision in hyperlinking topically relevant Web resources in which 83% of hyperlinks could be restricted to resources of reading grade-level 8 or less. In the final evaluation by expert feedback, SemLink generated 65% topically relevant hyperlinks as agreed by the majority of the experts. SemAssist is designed as an interactive ontology-based Clinical Decision Support System to assist EDS authors in providing optimal medication advice for patients. The system offers a pre-formulated auto text and an alert critique about the inclusion of advice on side effects, required patient actions and follow-up related to postdischarge care for a set of high risk medications. Together, SemLink and SemAssist illustrate the application of a semantic annotation framework to support consumers in getting the most from their EDSs by exploiting both dynamic hyperlinking and authoring support. Our approach may have a wider range of applications to support other health-related document types and clinical users.
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Hayes, Karen S. "Geragogy-based medication instruction for the rural elderly patient discharged from the emergency department." free to MU campus, to others for purchase, 1996. http://wwwlib.umi.com/cr/mo/fullcit?p9812954.
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Griffiths, Pauline. "Nursing patients in transition : an ethnography of the role of the nurse on an Acute Medical Admissions Unit." Thesis, Swansea University, 2007. https://cronfa.swan.ac.uk/Record/cronfa42820.
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This thesis explores the role of the nurse on an Acute Medical Admissions Unit (AMAU). AMAUs provide a dedicated area for the assessment, treatment, and subsequent transfer or discharge of patients who are medical emergencies. Despite increasing numbers of AMAUs across the UK they are an under researched area and, in particular, there is limited research that has explored the role of the nurse in the AMAU setting. Data were generated through the use of ethnography that entailed participant observation over an eighteen-month period, semi-structured interviews with a purposive sample of doctors, nurses, paramedics, and patients (n= 19), and examination of documentary evidence. Drawing on the concept of communities of practice (Wenger 1998) and the demand-control-social support model of occupational stress (Baker et al., 1996) the key themes of the study were identified as: The AMAU nurse's role in co-ordinating patients ' transition; Professional skills and attributes o f the AMAU nurse; 7 love the buzz': the AMAU nurses' work place stresses and balances; and Organisational constraints and practice boundaries for AMA U nursing The findings from the study indicate that a key aspect of the AMAU nurse's role was the facilitation of rapid patient transition. In addition the study has identified the distinctive and locally negotiated working practices developed by the nurses to coordinate this transition. Another important claim arising from this study was the identification of this nursing role as an evolved construction within a community of practice. This study makes a significant contribution to the limited body of knowledge regarding AMAU nursing practice by aiding understanding of the complexity of this nursing role. Additionally, the application of the concept of community of practice provides a unique perspective and insight into this under explored role. Recommendations are offered for practice, education, management and future research.
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Olsen, Rose Mari, Ove Hellzen, Liv Heide Skotnes, and Ingela Enmarker. "Content of nursing discharge notes: Associations with patient and transfer characteristics." Mittuniversitetet, Institutionen för hälsovetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-17468.
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Background: In situations of care transfer of older people from hospital to home care at discharge, exchanging relevant and necessary information about the patient’s health status and individual needs are of importance to ensure continuity and appropriate nursing follow-up care. Objective: The objectives of the study were to: 1) examine the content of nurses’ discharge notes of older patients’ discharged from hospital to home care, and 2) investigate the association between the content of discharge notes and characteristics of patient and transfer. Methods: The nursing discharge notes of 70 older patients admitted to a geriatric unit and a general medicine ward at a local hospital in central Norway were analysed. The discharge notes were structured in accordance with the Well-being, Integrity, Prevention, and Safety (VIPS) model. Mean, standard deviations, and independent sample t-tests were performed to show and examine differences in use of VIPS keywords in relation to patient and transfer characteristics. To examine if use of VIPS keywords could be predicted by patient and transfer characteristics, linear multiple regression analyses were used. Results: Significant differences for mean scores on used VIPS keywords in the discharge note were found for gender, age, and medical department facility. While gender and medical department facility were significant predictors of mental related keywords in the discharge note, medical department facility was a significant predictor of physical related keywords. Conclusions: The result of this study indicate that documentation of patient status in the nursing discharge note of older patients transferred from hospital to home care is incomplete and are influenced by patient and transfer characteristics. In order to ensure continuity and appropriate nursing follow-up care, we emphasize the need for a more comprehensive approach to older patients, and that this must be reflected in the nursing discharge note.
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Hennessy, Carrie Olsen. "Monitoring Psychiatric Patients’ Preparedness for Hospital Discharge." Antioch University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1521494115246141.
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Lauck, Sandra Béatrice. "Factors associated with patient outcomes following same-day discharge percutaneous coronary intervention." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/31802.
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Coronary artery disease continues to cause the majority of deaths and disability in Canada; the resultant demand for percutaneous coronary intervention (PCI) exercises constant pressure on health care systems to meet the growing needs of patients. The practice of same-day discharge PCI has emerged as a medically safe option to optimize resource utilization and to improve access to care. The purpose of this study was to describe elective same-day discharge PCI patients' health behaviour in the two to five days following their procedure. The concepts of cardiac self-efficacy and self-care agency provided a theoretical framework. A telephone questionnaire drawing from existing validated tools was developed to explore the relationships between patient and procedural characteristics, and individuals' capacity to care for themselves following PCI in a study sample of 98 participants. The findings revealed a high degree of adherence to the discharge guidelines, including following medication regimen, making a follow-up appointment, and managing the dressing. Yet, within 24 hours of discharge, over 30% of patients experienced symptoms of myocardial ischemia, with 80% opting to take no action, and a further 10% of the total sample presented to an emergency department. Participants' awareness of how to appropriately manage their chronic disease was low: although over 70% of patients understood the results of their PCI procedure, 38% believed that they no longer had coronary artery disease, 50% did not know how to prevent their heart disease from worsening, and 77% did not intend to participate in cardiac rehabilitation. To identify factors associated with lower levels of CSE and SCA, multiple linear regression analysis was carried out. Lack of social support emerged as a significant and consistent predictor of poorer outcomes. In addition, other aspects of psychoemotional distress were also significant factors in patients' cardiac self-efficacy and self-care agency in the recovery period. Same-day discharge PCI presents a feasible and safe option for delivery of care for most patients, but requires improved bridging between acute intervention and chronic disease management, and the identification of tailored interventions or support for individuals at higher risk during the recovery period.Applied Science, Faculty of
Nursing, School of
Graduate
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Templeton, Karen Jobe. "In tandem or in tension? Patient-nurse negotiations from ICU to hospital discharge." Thesis, The University of Arizona, 1988. http://hdl.handle.net/10150/292039.
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Using grounded theory methodology, six intensive care patients were interviewed regarding their perceptions of their own needs, concerns and wants and how nurses responded to those. Each patient was interviewed three times to detect any change in responses during the hospitalization. A theme of patient-nurse negotiation emerged. Patients came into the health care setting with a "generative source," the issues and beliefs they had regarding health-care and nurses in general. This affected patients' definition of themselves, their situation, the caregiver, their relationship with the caregiver, and their own needs and expectations. When a patient's definitions of self or situation varied form the nurse's, negotiation would occur. Two main categories of negotiation were used by both patient and nurse: Personal knowledge & Strategies. If negotiation failed to bring consensus, resulting actions were negative feelings and dissatisfaction, and a sense of vulnerability for the patient. This in turn impacted negatively on the patient's generative source and definitions. As the patient progressed through the hospital system toward discharge, the greatest changes were noted in how they defined themselves and the caregiver, and in the style of negotiation they used.
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Arbuckle, Lon Michel Luk. "Short-Term Occupancy Prediction at the Ottawa Hospital Using Time-Series Data for Admissions and Longitudinal Patient Data for Discharge." Thesis, Université d'Ottawa / University of Ottawa, 2012. http://hdl.handle.net/10393/20545.
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The Ottawa Hospital cancels hundreds of elective surgeries every year due to a lack of beds, and has an average weekday occupancy rate above 100%. Our approach to addressing these issues, by way of informing administrators of resource needs, was to model the flow of patients coming and going from the hospital.
We used administrative data from the Ottawa Hospital to build a time-series model of emergency department admissions, and studied models that would predict next-day discharge of patients currently taking up hospital beds. In the latter, we considered population-averaged models for groups of patients based on their primary medical condition, as well as subject-specific models. We included the random effects from subject-specific variation to improve on predictive accuracy over the population- averaged approach. The result was a model that provided more realistic probabilities of discharge, and stable predictive accuracy over patient length of stay.
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Fyfe, Kristen, Tiffany Lee-Chan, Heather Marrow, Janet Cooley, and Terri Warholak. "The Effect of Follow-Up Phone Calls After Patient Discharge on 30-day Hospital Readmission Rates." The University of Arizona, 2014. http://hdl.handle.net/10150/614153.
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Class of 2014 AbstractSpecific Aims: The objective of this study was to perform follow-up phone calls to patients after discharge to determine if it had a significant effect in lowering 30- day readmission rates. Methods: Men and women aged 18 years and older who provided informed consent participated in this prospective, pre-post study. The intervention consisted of a scripted follow-up phone call to each patient after discharge. At three to seven days post-discharge, a pharmacy student on an advanced pharmacy practice experience rotation at a teaching hospital called each patient discharged from a designated ward (Med/Surg I), which admits patients with a variety of conditions, such as liver cirrhosis, pneumonia, osteomyelitis, those who are uninsured, or those who require placement after discharge. Information was collected regarding prescription filling, understanding of medication(s), concerns regarding medications, and the community pharmacy he/she used to fill the discharge medications. The specified community pharmacy was then called to verify that the patient filled discharge medications at that pharmacy. The results were compared to the readmission rate in the same ward over the same time period one year prior to implementation of the intervention. Chi-square and descriptive analysis was used and the alpha a priori is 0.05. The institutional review board approved this study. Main Results: Of the 315 people contacted, a total of 89 people completed the survey (28% response rate) and 11 of these participants were readmitted at least once. There was no statistically significant difference between the participant readmission rate and the readmission rates of the total unique admission population of Med/Surg I in 2013 (χ2 = 1.206; p = 0.272). Conclusion: Follow-up phone calls did not significantly impact 30-day readmission rates; however, a downward trend was observed in the participant group.
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Fylan, Beth. "Medicines Management after Hospital Discharge: Patients’ Personal and Professional Networks." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14465.
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Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.University of Bradford studentship
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Fylan, Gwynn Elizabeth Margaret Mary. "Medicines management after hospital discharge : patients' personal and professional networks." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14465.
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Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored.
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Kydd, Angela. "Life in limbo : a study of delayed discharge from a policy and patient perspective." Thesis, University of Aberdeen, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.439946.
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This qualitative study took place over a four-year period and explored both the phenomenon of ‘delayed discharge’ and the experience of the frail older people classed as ‘delayed discharges’. The study set out to answer three research questions:- Given that this is not a new concept, why does the phenomenon and process of delayed discharge remain an issue for the Health Service in Scotland? What is life like for frail older people living in this state of transition? Can pragmatic guidelines for health care providers working with people in transitional states be designed from answers to the first two questions? The study borrowed from ethnography, and using the underlying philosophy of symbolic interactions attempted to view the subject from several different stances. Nine different methods were used to collect the data. The period of data collection lasted from November 2001 to November 2005, and during this time, the health and welfare state was changing rapidly. Changes were constant and the two most successful methods of keeping up to date were to interview people in the field and to review media reports. The main findings showed that frail older people in transition were anxious about their futures. However, the findings from the entire study showed that staff were too stressed to be able to provide evidenced-based care for their patients. They were also in transition and their own personal anxieties about organisational changes meant they were unable to support or comfort the frail older people in distress. The recommendations from this study suggest that qualified staff in health and social work posts, at all levels, need to be supported during periods of change by their seniors. With support, they might support unqualified frontline staff, who in turn will then be able to care for patients in distress.
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Gregory, Margaret F. "Client/patient need at the interface between health and social services on discharge from an acute general hospital." Thesis, University of Nottingham, 1997. http://eprints.nottingham.ac.uk/13047/.
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One thousand four hundred and twenty two patients in an Acute General Hospital in Mansfield were studied over a one year period, 1989-90, in order to determine their needs for formal and informal care on discharge. The research method included a screening project for 189 patients on admission, an analysis of 1064 referrals to the Hospital Social Workers, and 169 referrals to the Hospital Discharge Scheme for Volunteer support. Patient/client needs for formal and informal care were found, and unmet needs after Hospital discharge were identified. Problems relating to formal care systems and shortage of Public Sector resources were found to cause serious difficulties for patients and Carers. The availability of Carers and lack of family members in informal care structures was a key issue. The work showed how Volunteers from the Discharge Scheme were able to contribute to the work of formal and informal Carers and ensure that safe Hospital Discharges occurred for very vulnerable people.
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Welch, Brenda Elaine. "Patient Views on Social Media Communication with Their Health Care Providers." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6872.
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Communication between patients and health care providers at hospital discharge is a critical factor that determines whether a patient understands their treatment plan and self-care instructions. Lack of effective health management after hospital discharge can decrease the quality of life for a patient and increase the likelihood of costly hospital readmission. The purpose of this phenomenological study was to explore factors affecting the receptivity of patients using social media as a platform for post discharge, provider-client communication, and assessment. This was explored using social presence theory. Twenty patients between 45 to 65 years of age, who received care from hospitals in Northeast Ohio, were interviewed for the study. The data was transcribed and analyzed through open coding to create themes and clusters. The themes that emerged from this study were ease of use, privacy, and convenience as well as reasons why participants may access health-related social media being specifically linked to cohesive factors of ownership of their data. The personal relationship established between patient and provider influenced communication methods. Social connections were also deeply-rooted themes in the study as the influence of other people or the need to access data were among reasons for choosing to use social media. Ease of access, importance of confidentiality, quick response time from providers, and ability to see personal medical information was important to the participants in social media communications with providers. The positive social change implications of this study are that communication issues at discharge could be mitigated if patients would accept using social media for communication with their health care providers once they are at home.
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Ericsson, Carin. ""Det känns kul när man kan förbättra saker för patienterna" : En fallstudie av ett förbättringsarbete som syftar till trygg utskrivning från sjukhus." Thesis, Hälsohögskolan, Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-30608.
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För patienterna är det viktigt att övergången mellan olika vårdgivare sker på ett tryggt och säkert sätt som underlättar den fortsatta vården. Forskning visar att patienternas delaktighet i förberedelser inför utskrivning från sjukhus ofta brister. Sjuksköterskorna på vårdavdelningen upplevde att arbetet inför utskrivning var stressigt. Syftet med förbättringsarbetet var att identifiera och implementera åtgärder som möjliggör en välfungerande och trygg utskrivningsprocess. Syftet med studien av förbättringsarbetet var att identifiera faktorer av betydelse för implementeringen av förbättringsåtgärder på en vårdavdelning.Metoden för genomförande av förbättringsarbetet följde principerna för förbättringsrampen. Studien av förbättringsarbetet var en fallstudie med explorativ ansats. Data om personalens erfarenheter av förbättringsarbetet inhämtades med intervjuer som analyserades med kvalitativ innehållsanalys. Resultatet av förbättringsarbetet visade inte någon mätbar förbättring av utskrivningsprocessen. Resultatet av studien visade att vårdpersonalen ändå upplevde förbättringar och att motivation och praktiska förutsättningar för att delta var viktiga för resultatet. Slutsatsen var att förbättringsarbetet var värdefullt och medförde ett lärande, även om mätbara mål inte uppnåddes. Ledningsens engagemang var viktigt för att skapa möjligheter för personalen att delta i förbättringsarbete. Valet av förbättringsområde hade stor betydelse för resultatet då det påverkade de medverkandes motivation."It feels great when you can improve things for the patients" Safe hospital discharge, a case study of an improvement work An important aspect of health care, from the patient’s perspective, is to achieve smooth and efficient transitions between different health care providers. Current research shows that the patient’s involvement in discharge planning before leaving the hospital is often deficient. Furthermore, nurses at the hospital ward experience discharge planning as stressful work. The aim of the improvement work was to identify and implement measures for improving discharge process. The method underlying this improvement work is referred to as “the improvement ramp”, and an exploratory case study was carried out. Data was collected, by interviewing health professionals, and analysed using qualitative content analysis. The results of the implemented measures show no measurable improvements in the discharge process. However, the interviews indicate that health professionals experienced improvements in their daily routines. The conclusion was that the improvement work was valuable and resulted in a developed learning although the measurements didn’t capture all results. The choice of area for improvement was of great importance because it affected the participants' motivation.
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King, Tracey L. "The impact of a nurse-driven evidence-based discharge planning protocol on organizational efficiency and patient satisfaction in patients with cardiac implants." Orlando, Fla. : University of Central Florida, 2008. http://purl.fcla.edu/fcla/etd/CFE0002188.
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Fletcher, Kimberley J. "An interpretative phenomenological analysis of the patient experience of awake craniotomy : brain tumour diagnosis to discharge." Thesis, University of Nottingham, 2011. http://eprints.nottingham.ac.uk/12124/.
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Introduction. This thesis explored patient experiences of awake craniotomy. Existing literature is scarce and dominated by quantitative methodologies. More recently two qualitative studies have provided a rich, but contrasting, understanding of the patients‟ experience of awake craniotomy. The methodological weaknesses of the existing literature are addressed, and the rationale for the study justified. Objectives. The aim of the study was to explore seven participants‟ experiences of awake craniotomy using interpretative phenomenological analysis. Methods. Single-site ethical approval was gained to conduct the study in one NHS Trust. All potential participants were approached who had undergone the awake craniotomy procedure at the NHS Trust. Semi-structured interviews were conducted with participants. Interviews were transcribed verbatim and analysed using an interpretative phenomenological analysis framework. Results. Analysis of transcripts yielded three superordinate themes: self-preservation, operation environment and information. The superordinate themes were interpreted as interconnected with each other, as well as embedded in a core theme: relationship with the neurosurgeon. The three superordinate themes are presented and discussed within the journal article. The extended paper elaborates on two of these superordinate themes. Discussion. The relationship with the neurosurgeon appears crucial to the patients‟ experience of awake craniotomy. The relationship could impact on the participants‟ decision to have the awake craniotomy, their experience of the awake operation and their acceptance of the information given. The results are discussed with reference to previous literature. The implications and recommendations for further research are outlined.
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Kinney, Rebecca L. "Predictors of Patient Activation at ACS Hospital Discharge and Health Care Utilization in the Subsequent Year." eScholarship@UMMS, 2018. https://escholarship.umassmed.edu/gsbs_diss/992.
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Background. AHA guidelines have been established to reduce Acute Coronary Syndrome (ACS)-related morbidity, mortality and recurrent events post-discharge. These recommendations emphasize the patient as an engaged member of the health care team in secondary prevention efforts. Patients with high levels of activation are more likely to perform activities that will promote their own health and are more likely to have their health care needs met. Despite evidence and strong expert consensus supporting patients as active collaborators in their own ACS care, the complexity and unexpected realities of self-managing one’s care at home are often underestimated. This study seeks to examine the correlates of patient activation at hospital discharge and then identifies activation trajectories in this same cohort in subsequent months. Lastly, this study examines the association between patient activation and health care utilization in the year subsequent to an ACS event.
Methods. This study incorporates three aims: Aim 1, identification of the correlates of low patient activation post-discharge; Aim 2, identification of patient activation trajectories among this same cohort in the months following hospitalization; and Aim 3, examination of the association between patient activation and health utilization, post-discharge.
Results. Fifty-nine percent of ACS patients identified as being at the lowest two activation stages at the time of hospital discharge. Perceived stress (pidentified post-discharge: low, stable (T1), high, sharp decline (T2), and sharp improvement (T3). The majority of patients (67%) identified as being in T1. Those patients of older age (OR: 2.22; CI 1.4- 3.5), identifying as Black in race (OR: 2.14: CI 1.1- 4.3), and reporting moderate/high perceived stress (OR: 2.54: CI 1.4- 4.5) had increased odds of being in the low, stable trajectory. The bivariate analysis indicated a significant association (P=0.008) between low patient activation and self-reported hospital readmissions in the months following discharge. In the final model, moderate to severe depression (OR: 1.60; CI 1.1- 2.3) was the strongest predictor of readmissions in the 12 months subsequent to discharge.
Conclusions: Patients reported low activation at hospital discharge after an ACS event indicated that these patients were not prepared to take an active role in their own care. Correlates of low activation at discharge include moderate to high perceived stress, depression, and low social support. Furthermore, in the months following hospital discharge, the majority of these patients followed either a low/stable or a sharp decline activation trajectory. Hence, these results suggest that over time patients feel less and less confident to take an active role in self-management. Lastly, we found that patient activation may impact healthcare utilization in the year subsequent to hospital discharge, although patient self-reported depression appears to be the strongest predictor of utilization in the subsequent year. Future research is needed to better understand the relationship(s) among patient activation, depression, and health care utilization.
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Bauld, Linda C. "Older patient participation in multi-disciplinary decision-making : discharge planning in Scotland and British Columbia, Canada." Thesis, University of Edinburgh, 1998. http://hdl.handle.net/1842/21490.
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An increasing proportion of older people today are returning to their own homes following discharge from hospital. The aim of community care policies in both Britain and Canada has been to provide these older people with the services necessary to continue living independently in the community. The maintenance of this independence is dependent upon effective discharge planning. There are four stages of discharge planning: assessment of the patient's needs; planning which services will be required by the patient after release from hospital; implementation of these services; and follow-up to determine whether the patient's needs are being met by the implemented discharge plan. Discharge planning is therefore a multi-disciplinary decision-making process involving negotiation between a variety of hospital based health and social care practitioners, the patient and his or her carers, and community service agencies. The older patient's involvement in this decision-making process serves as the focus for this research. The aim of this comparative study was to determine what role older patients play in discharge planning, to what extent they are permitted to be involved and to what extent they wish to be involved. The research setting for this qualitative study was two geriatric assessment and rehabilitation units, one in Scotland, the other in British Columbia, Canada. Older patients and health and social care practitioners were interviewed in each unit. Following release from hospital, these older patients were also interviewed in their own homes. Findings from these interviews, combined with observation and document analysis, demonstrate how each ward attempted to facilitate patient input in planning and what patients' and professionals' views of participation were. Findings also reveal a relationship between patient participation and discharge outcomes in each country, and suggest ways in which greater patient involvement can be introduced into the discharge planning process in order to attain continuity of care between the hospital and the community.
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Choe, Angela Y. "Understanding Discharge Communication for Hospitalized Patients and Caregivers with Limited English Proficiency." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1553617601030777.
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Björk, Andersson Ellinor, and Nadine Dranichnikova. "Traumapatienters upplevelse av information inför hemgång : En kvalitativ intervjustudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-295057.
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Bakgrund: Tidigare forskning visar att traumapatienter oftast känner sig oförberedda inför hemgång. Detta beror bland annat på bristande patientinformation vid utskrivningen. Tydlig och saklig information som ges till traumapatienter vid utskrivningen kan bidra till att traumapatienter känner sig trygga och mer förberedda inför hemgång. Syfte: Syftet med denna studie är att belysa vilken information traumapatienter upplever att de får inför hemgång, om de är tillfredsställda med den information som givits och om informationen kan förbättras. Metod: Sju deltagare som hade varit traumapatienter under år 2014-2015 på ett universitetssjukhus i Sverige rekryterades. Deltagarna var i varierande åldrar, kön och hade en varierad skadebild. Semistruktuerade telefonintervjuer utfördes efter kontakt med deltagare via brev och telefon. Insamlad data har analyserats via kvalitativ innehållsanalys. Resultat: Resultatet av denna studie har visat att en del traumapatienter fått muntlig information om hjälpmedel, känslor och reaktioner som kan uppstå efter ett trauma, läkemedel som de får med sig vid utskrivningen, nedtrappningsschema för starka opioider, skadan de blivit utsatta för samt vidare uppföljning. Den information som deltagarna fick inför hemgång bidrog till att de kände sig införstådda, tillfredsställda och trygga. Deltagare uppgav att de fått otillräcklig information om aktivitet, hygien, infektionstecken, läkemedel och biverkningar, känslor och krisreaktioner, nedtrappningsschema för starka opioider, normalt läkmönster, skada, smärta, stöd - var kan man vända sig om man har frågor och vid eventuell försämring eller utebliven förbättring, sårvård, uppföljning och återbesök. Detta gjorde att deltagarna uttryckte besvikelse, missuppfattning, oro, ovisshet, osäkerhet och önskade mer information. Slutsats: Studiens resultat visar att vissa traumapatienter önskar mer och tydligare information vid utskrivning.Background: Previous studies have shown that trauma patients often feel unprepared at discharge due to a lack of patient information. Explicit and relevant information that is given to trauma patients at discharge can contribute to trauma patients feeling more secure when going home from a hospital. Aim: The aim of this study is to demonstrate what information trauma patients perceive they are getting when going home from hospital, if they are satisfied with the information that is given, and if the information can be improved. Method: Seven participants who had been trauma patients during 2014-2015 at a university hospital in Sweden were recruited. The participants varied in age, gender and trauma (injury). Semi structured telephone interviews were implemented after being in contact with the participants by letter and phone. All the collected data has been analyzed through qualitative content analysis. Results: The result of this study has shown that some trauma patients received verbal information about mobility aids and equipment, feelings and reactions that can occur after trauma, new medicines and how and when to stop taking them, their injury, and follow-ups. The information the participants got made them feel informed, secure and satisfied. Participants also reported that they had received insufficient information regarding activity, hygiene, signs of infection, medicines and its potential side-effects, how and when to stop taking strong painkillers, feelings and reactions of crisis, their injury, a normal healing process after an injury, pain control, support - where to seek information, support in case of deterioration or absence of improvement despite medication and treatment, how to take care of wounds and planned follow-ups. The lack of this information contributed to the fact that participants felt disappointed, poorly informed, anxious, uncertain and insecure. Furthermore participants reported that they would appreciate more explicit information. Conclusion: The result of this study shows that some trauma patients need more explicit information at discharge.
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馮美玲 and Mei-ling Fung. "Stroke rehabilitation: predicting LOS and discharge placement." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31970515.
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郭穎怡 and Wing-yee Eunice Kwok. "Early supported discharge program for stroke patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40720883.
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Miller, E. F. Ruth. "Targeted discharge planning of hospitalised elderly patients." Thesis, Queen's University Belfast, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.314100.
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Kwok, Wing-yee Eunice. "Early supported discharge program for stroke patients." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B40720883.
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Gallo, Maria L. "Nursing advocacy and the accuracy of intravenous to oral opioid conversion at discharge in the cancer patient." [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0003235.
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Gallo, Maria L. R. N. O. C. N. "Nursing Advocacy and the Accuracy of Intravenous to Oral Opioid Conversion at Discharge in the Cancer Patient." Scholar Commons, 2009. https://scholarcommons.usf.edu/etd/1978.
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Pain is a common problem for cancer patients at home and when hospitalized. Pain interferes with all aspects of a patient's life including sleep, appetite, sexual desire, emotion and productivity. The under-prescribing of opioids can lead to uncontrolled pain in cancer patients. This study examined nursing advocacy related to pain management and the accuracy of the intravenous (IV) to oral (PO) opioid conversion at discharge in cancer patients.
Retrospective chart audits were done on 50 cancer patients. The physicians in the charts surveyed who prescribed the discharge medications consisted of a mix of hematologist/oncologists, surgeons and internists/hospitalists in a southwest Florida community. Fifty nurses were also surveyed and asked how comfortable they are in advocating for their patient's pain control and how often they actually advocate for proper pain management. This was done in the same southwest Florida hospital.
The most common cancer diagnoses of the patient subjects were colorectal cancer and esophageal/lung cancer. The results of this study show that an overwhelming majority of cancer patients (47 of 50), received doses that were not accurately converted from intravenous to oral opioids at the time of discharge from the hospital. This conversion was based on the Johns Hopkins Opioid Conversion Tool. Nurses in general reported that they are comfortable in advocating for their patients' pain control, but more so in more autonomous areas of practice such as intensive care.
The results were overwhelming in the direction of poor control of patient pain. This study leads to the need for further research in the important area of pain control for cancer patients. It also indicates the need for additional education for physicians and nurses about pain control and opioid conversion.
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Badger, Martha Kimpton. "Patient Acuity as a Predictor of Length of Hospital Stay and Discharge Disposition After Open Colorectal Surgery." Thesis, The University of Wisconsin - Milwaukee, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10261705.
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Major areas of concern within the US healthcare system today include the quality and cost of healthcare. Open colorectal surgery patients have a higher prevalence of prolonged length of hospital stay (LOS) than most other types of surgery patients and are likely to be discharged to home care or other healthcare settings (DHCS), both of which contribute to increased costs. The ability to predict which patients are at risk for these outcomes early after open colorectal surgery could prompt nursing interventions aimed at improving quality of care and reducing healthcare costs. Radwin and Fawcett’s Refined Quality Health Outcomes Model served as the conceptual framework for this study.
In this retrospective cross sectional study of adult open colorectal surgery patients (N=789), nursing documentation in the electronic health record (EHR) was reused to examine the relationships among patient acuity, LOS, and discharge disposition (DD). At the large Midwest healthcare system where this study took place, a patient acuity software system generated real-time patient acuity scores from discrete nursing assessment data fields in the EHR. This information was being used by unit nurse managers to guide nurse staffing decisions.
Patient data were stratified by three discharge diagnostic-related groups (DRG) for colorectal surgeries, DRG 329, 330, and 331, to provide some control for comorbidities and post-operative complications. Multiple regression analysis for each DRG examined how patient acuity and select patient characteristics predicted prolonged LOS. Findings included that having a high patient acuity score on Day 2 or 3 after open colorectal surgery was a significant predictor of prolonged LOS for subjects in each DRG (DRG 329: B=1.985, p<0.05; DRG 330: B=1.956, p<0.01; DRG 331: B=0.967, p<0.01). Logistic regression analysis results also indicated that high patient acuity scores on Day 2 or 3 after surgery significantly predicted DHCS for each DRG (DRG 329: OR=3.65, 95% CI [1.39, 9.59], p<0.05; DRG 330: OR=2.86, 95% CI [1.58, 5.16], p<0.01; DRG 331: OR=8.62, 95% CI [2.04, 39.48], p<0.05).
Implications for nursing include the need for further research to examine the use of patient acuity information to support evidence-based clinical decision making to improve healthcare quality and contain costs.
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King, Tracey. "THE IMPACT OF A NURSE-DRIVEN EVIDENCE-BASED DISCHARGE PLANNING PROTOCOL ON ORGANIZATIONAL EFFICIENCY AND PATIENT SATISFACTION IN." Doctoral diss., University of Central Florida, 2008. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/3757.
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Purpose: Healthcare organizations are mandated to improve quality and safety for patients while stressed with shorter lengths of stay, communication lapses between disciplines, and patient throughput issues that impede timely delivery of patient care. Nurses play a prominent role in the safe transition of patients from admission to discharge. Although nurses participate in discharge planning, limited research has addressed the role and outcomes of the registered nurse as a leader in the process. The aim of this study was determine if implementation of a nurse-driven discharge planning protocol for patients undergoing cardiac implant would result in improved organizational efficiencies, higher medication reconciliation rates, and higher patient satisfaction scores. Methods: A two-group posttest experimental design was used to conduct the study. Informed consent was obtained from 53 individuals scheduled for a cardiac implant procedure. Subjects were randomly assigned to either a nurse-driven discharge planning intervention group or a control group. Post procedure, 46 subjects met inclusion criteria with half (n=23) assigned to each group. All subjects received traditional discharge planning services. The morning after the cardiac implant procedure, a specially trained registered nurse assessed subjects in the intervention for discharge readiness. Subjects in the intervention groups were then discharged under protocol orders by the intervention nurse after targeted physical assessment, review of the post procedure chest radiograph, and examination of the cardiac implant device function. The intervention nurse also provided patient education, discharge instructions, and conducted medication reconciliation. The day after discharge the principal investigator conducted a scripted follow-up phone call to answer questions and monitor for post procedure complications. A Hospital Discharge Survey was administered during the subject's follow-up appointment. Results: The majority of subjects were men, Caucasian, insured, and educated at the high school level or higher. Their average age was 73.5+ 9.8 years. No significant differences between groups were noted for gender, type of insurance, education, or type of cardiac implant (chi-square); or age (t-test). A Mann-Whitney U test (one-tailed) found no significant difference in variable cost per case (p=.437) and actual charges (p=.403) between the intervention and control groups. Significant differences were found between groups for discharge satisfaction (p=.05) and the discharge perception of overall health (p=.02), with those in the intervention group reporting higher scores. Chi square analysis found no significant difference in 30-day readmission rates (p=.520). Using an independent samples t-test, those in the intervention group were discharged earlier (p=.000), had a lower length of stay (p=.005), and had higher rates of reconciled medications (p=.000). The odds of having all medications reconciled were significantly higher in the intervention group (odds ratio, 50.27; 95% CI, 5.62-450.2; p=.000). Discussion/Implications: This is the first study to evaluate the role of the nurse as a clinical leader in patient throughput, discharge planning, and patient safety initiatives. A nurse driven discharge planning protocol resulted in earlier discharge times which can have a dramatic impact on patient throughput. The nurse driven protocol significantly reduced the likelihood of unreconciled medications at discharge and significantly increased patient satisfaction. Follow-up research is needed to determine if a registered nurse can impact organizational efficiency and discharge safety in other patient populations.Ph.D.
School of Nursing
Other
Nursing PhD
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Allgar, Victoria. "Physiotherapy from admission to discharge : an exploratory study." Thesis, University of Newcastle Upon Tyne, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.289094.
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Bråndal, Anna. "Rehabilitation after stroke with focus on early supported discharge and post-stroke fatigue." Doctoral thesis, Umeå universitet, Medicin, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-120127.
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Background Stroke is a major cause of disability worldwide. After treatment in a specialized stroke unit, early supported discharge (ESD) followed by home rehabilitation has shown to be an effective way to improve patient outcome and quality of care for persons with mild to moderate stroke. ESD service is recommended in the national and international guidelines for stroke care, but has only partially been implemented in Sweden. Following stroke, fatigue is a common consequence that often becomes more evident when the patient comes home. Currently, there is insufficient evidence about how to measure, treat and handle post-stroke fatigue. The overall aim of this thesis was to evaluate and implement early supported discharge (ESD) based on stroke patients experience after discharge from the stroke unit and local conditions. The aim was also to evaluate post-stroke fatigue with a potentially valid and reliable scale and finally to prepare for a study to evaluate cardiorespiratory training as a part of ESD service for patients with post-stroke fatigue. Methods In paper I, nine strategically chosen patients were interviewed of their experience of falling ill, the hospital stay, discharge, contact with health care after discharge and their request of support. Papers II-III describe and evaluate the development, content, implementation and effects of a locally adopted method for early supported discharge (Umeå Stroke Center ESD) in modern stroke care. Paper II included 153 consecutive patients and paper III, 30 232 patients with first-ever stroke registered in the Riksstroke registry in Sweden. Paper II evaluated number of patients/year, clinical and functional health status, satisfaction in relation to needs, accidental falls/other injuries and resources with the result summarized in a value compass. The implementation process was evaluated retrospectively by means of Consolidated Framework for Implementation (CFIR). Paper III evaluated patient reported outcome measurements (PROMs) at 3 months. The primary outcome in paper III was satisfaction with the rehabilitation after discharge. Secondary outcomes were information about stroke provided, tiredness/fatigue, pain, dysthymia/depression, general health status and dependence in activities of daily living (mobility, toilet hygiene and dressing). Multivariable logistic regression models for each PROM was used to analyze associations between PROMs and ESD/no ESD. In Paper IV, the Fatigue Assessment scale (FAS) was translated into Swedish and evaluated regarding psychometric properties when self-administered by persons with mild to moderate stroke. 72 consecutively patients selected from the stroke unit admission register received a letter including three questionnaires: the FAS, the Short Form Health Survey (SF-36) subscale for vitality and the Geriatric Depression Scale GDS-15. A second letter with FAS was sent within 2 weeks, for re-test evaluation. Paper V is a study protocol for a planned randomized controlled trial (RCT) of 50 consecutive stroke patients will who receive stroke unit care followed by ESD-service at Umeå Stroke Center, University Hospital, Umeå, Sweden. Paper V will investigate if a structured cardiorespiratory interval training program (CITP) added to the ESD-service may result in relieved post-stroke fatigue and increased oxygen uptake. Results The interviews in Paper I revealed three main categories with subcategories: “Responsible and implicated”, “Depersonalized object for caring measures” and “The striving for repersonalization and autonomy”. The findings indicate that coming home gave the informants’ important insights and understanding of the stroke, its consequences and was also an important factor for the recovery. Paper II-III showed that it is possible to develop and implement an adapted ESD service for stroke patients based on the patients’ experiences and requests, evidence-based recommendations and local conditions. The ESD service reduced dependence of activity, increased mobility with seemingly no increased risk of accidental falls or other injuries. The patient satisfaction in relation to needs regarding the ESD was high. Paper III showed that patients that received ESD were more satisfied with rehabilitation after discharge, had less need for assistance with ADL and less dysthymia/depression compared to patients that did not receive ESD. Study IV showed that the Swedish FAS used at home as a selfadministered questionnaire is a reliable and valid questionnaire for measuring fatigue in persons with mild to moderate stroke. The internal consistency was good, the agreement between the test and retest reliability for individual items (weighted kappa) was for the majority of items good or moderate. The relative reliability for total scores was good and the absolute reliability was 9 points. The Swedish FAS had no floor nor ceiling effects and correlated both with the SF-36, subscale for vitality and the GDS-15 indicating convergent construct validity, but not divergent construct validity. Conclusion It is possible to develop and implement ESD care for stroke patients based on patients’ experience and needs, evidence-based principles and local conditions. Early supported discharge (ESD) in the setting of modern stroke unit care appears to have positive effects on rehabilitation in the subacute phase. The Swedish FAS used at home as a self-administered questionnaire is reliable and valid for measuring fatigue in persons with mild to moderate stroke.
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Popejoy, Lori L. "Hospital discharge destination decisions exploring congruence in frail elders, their family members, and health care teams' decisions /." Diss., Columbia, Mo. : University of Missouri-Columbia, 2007. http://hdl.handle.net/10355/4822.
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Thesis (Ph. D.)--University of Missouri-Columbia, 2007.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. "August 2007" Includes bibliographical references.
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Afra, Elnas. "Patienters upplevelse av utskrivning till hemmet från en dagkirurgisk enhet : En intervjustudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-156206.
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Syfte: Att beskriva dagkirurgiska patienters upplevelse av att bli utskrivna hem samma dag efter operation utförd i generell anestesi. Metod: Kvalitativ intervjustudie med induktiv ansats. Elva patienter som har opererats via en handkirurgisk mottagning i mellersta Sverige har intervjuats utifrån en semistrukturerad intervjuguide. Sju kvinnor och fyra män i åldrarna mellan 28-71 år har deltagit i studien. Innehållsanalys användes för analys av materialet. Resultat: Patienterna upplevde hemgången som väldigt positiv. De faktorer som bidrog till en lyckad hemgång var framförallt; Patientens goda grundhälsa, en trygg hemmiljö att återvända till och återhämta sig i, samt att patienterna får sina frågor och funderingar besvarade inför hemgången, och stöd från anhöriga. Vårdpersonalens bemötande och professionella förhållningssätt bidrog till att patienterna upplevde en känsla av trygghet som skapade en förutsättning för delaktighet. Resultatet visar även att patienter önskar mer information om det postoperativa förloppet. Slutsats: Att skrivas ut och komma hem efter ett dagkirurgiskt ingrepp är en positiv upplevelse för patienterna, dock behöver informationen inför hemgången samt möjligheten till stöd från den dagkirurgiska enheten efter hemgången förbättras.Aim: To describe the day-surgery patients´ experience to be discharge the same day after surgery in general anesthesia. Methods: Qualitative interview study with inductive approach. Eleven patients, operated by a hand surgical receptions in central Sweden were interviewed, using a semi- structured interview guide. Seven women and four men between 28-71 years participated in the study. Content analysis was used for analysis of the material. Result: Patients experienced the discharge as very positive. The factors which contributed to a successful discharge was above all, patient good basic health, a safe home to return to and recover in, and that the patients have their questions and concerns answered before discharge, and the support from relatives. Health professionals' reception and professional approach helped the patients to feel a sense of security that created a condition for participation. The results also show that patients want more information about the postoperative recovery. Conclusions: To be discharged, and come home, after day surgery procedures is a positive experience for patients, however, the information at discharge and the possibility of support from the day surgery unit after discharge needs to improve.
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Manges, Kirstin. "Transition to home study: the influence of interprofessional team shared mental models on patient post-hospitalization outcomes." Diss., University of Iowa, 2018. https://ir.uiowa.edu/etd/6193.
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Background: The quality of team-based care impacts patient post-hospitalization outcomes, yet there is a gap in our understanding of how specific team processes impact patient post-hospitalization outcomes. Shared Mental Models (SMMs) is a team process from organizational psychology; it provides an understanding of how providers coordinate complex tasks as a team. SMMs are the team members’ organized knowledge needed for effective team performance. Military research shows that teams with more convergent SMMs have higher performance and better outcomes. In healthcare, patient discharge exemplifies an activity that requires a high level of coordination among interprofessional team members. Two relevant domains of SMMs are Taskwork SMM (team assessment of patient’s readiness for hospital discharge) and Teamwork SMM (quality of day of discharge teamwork). Because of the newness of SMM to healthcare, we lack measures to understand SMMs among interprofessional discharge teams.
Study Purpose & Aims: The purpose was to pilot a novel measurement approach assessing SMMs of discharge teams, and explore their relationships to patient 30-day post-hospitalization outcomes (quality of care transition and utilization of unplanned medical services). Aim 1 determined the content and degree of convergence of discharge teams’ SMMs (taskwork and teamwork). Aim 2 examined the relationship between discharge team SMMs and patient post-hospitalization outcomes.
Methods: A prospective longitudinal pilot study was used to examine the SMMs of 64 unique discharge events in three inpatient units at a single hospital. Discharge team members independently completed a questionnaire measuring the Teamwork SMM (using the Shared Mental Model Scale) and the Taskwork SMM (using the Discharge Provider-Readiness for Hospital Discharge Scale). Data were collected from the patient 30 days post-discharge to determine the quality of transition (using the Care Transition Measure or CTM-15) and use of unplanned utilization of medical services (unplanned readmission or ED visit). Interrater Agreement (r*wg(j)) was used to determine the SMM convergence (or level of agreement) among the discharge team. The relationship between SMMs and the quality of transition outcome (n = 42) was determined using standard regression analysis. Logistic regression was used determine the relationship of SMMs with utilization of unplanned medical services (n = 56).
Results: Overall, discharge teams reported high levels of Taskwork SMMs (M = 8.46, SD =.91) and Taskwork SMM Convergence (M = .90, SD =.10), indicating that the discharge team perceived and agreed that patients had high levels of readiness for hospital discharge. Discharge teams also reported having high-quality Teamwork SMMs (M = 6.11, SD = 0.39) and Teamwork SMM Convergence (M = .85, SD = .10), suggesting that most discharge teams perceived and agreed that high quality teamwork was provided during the discharge process. Discharge events from the three inpatient units significantly differed in their Teamwork and Teamwork SMM content and convergence scores. Discharge teams’ Teamwork SMMs and Taskwork SMMs were positively associated with the CTM-15 score, while controlling for key contextual factors (t = 3.94, p = .001; t = 3.94, p = .001, respectively).
Conclusion : Discharge teams’ Taskwork SMM and Teamwork SMM was positively associated with patient-reported quality of transition from the hospital. There was insufficient evidence to support that utilization of unplanned medical services is related to discharge teams’ SMMs. Measuring the SMMs of the discharge team provides a method for assessing a team process critical to safe patient discharges.
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Carew, Debra. "Discharge information needs of outpatient cardiac catheterization patients." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0001/MQ46121.pdf.
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Selman, Jennifer M. "Improving discharge readiness in elderly patients and families." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ59478.pdf.
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Haire, Tracey Marie. "Alleviating Discharge Confusion for Older Patients Using the Teach-Back Method." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3684.
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Discharge instructions and medication directions can be overwhelming for older adults, which can lead to potential medication errors, noncompliance, readmissions, and patient safety concerns. At a specialty lung clinic, the goal is to improve patient safety and to decrease the chance of errors by standardizing the discharge process via a Teach-Back education policy and protocol. Without consistency, there is a potential for mistakes and misunderstandings. The Agency for Healthcare Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI) considers the Teach-Back discharge method as best practice and should be considered universal practice among health care workers. Using the Always Use Teach-Back Toolkit for education and evaluation provided strategies and resources for the project. Five nurse practitioners and a physician assistant, who are responsible for discharge instructions, participated in the study by viewing an online teaching module and completing written surveys. The Conviction and Confidence Tool revealed 100% of the clinicians agreed that Teach-Back education was '10-Very Important' and were '10-Very Confident' in their abilities to apply the Teach-Back methods using a 1-10 Likert scale. Likewise, the practitioners showed significant improvements when comparing the pre-implementation and one-month, post-policy implementation, as indicated in the paired t test of the second part of the Conviction and Confidence Teach-Back Tool. Nursing plays a pivotal role in positive social change by using an evidence-based education method, which improves patient care through medication compliance and decreased readmission rates, thus showing significant transformation in chronic health management.
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Efraimsson, Eva. "Vårdplaneringsmötet : en studie av det institutionella samtalet mellan äldre kvinnor, närstående och vårdare." Umeå : Omvårdnad, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-590.
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Helgesson, Pernilla, and Benevides Berit Långström. "Patienters uppfattning av information vid utskrivningen från en urologisk vårdavdelning." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-320224.
Full textAbstract:
The purpose of the study was to investigate the perception of given information at discharge from a urological ward at Akademiska sjukhuset, and to investigate whether the patients had searched for information themselves after discharge. The study is an empirical cross -sectional study with descriptive design. All the patients inscribed as urologic patients, discharged to their home during month of March 2009, were asked to participate in the study (in total 82 patients), which led to 57 participants. The data collection method was an interview over the phone, with 20 structured questions. The interview form was sent by mail to the patients after the discharge from the ward, the authors thereafter called the participants at home and performed the interview within 10-20 days after discharge. The most common concerns for surgical patients after discharge are wound care, pain management, daily activity, the detection of complications, handling symptoms, elimination and quality of life. This study shows that 72 % of the participants considered the given information as sufficient for handling their self-care at home. The lack of information experienced by the participants concerned daily activity, eventual complications that may occur and pain management. The majority of the discharge information was given in the patient room. Postoperative complications that occur after discharge can be expensive for the society and is a cause of unnecessary suffering for the patient, therefore the patient need to understand what to be observant of after discharge. This requires that both doctors and nurses provide relevant information for each individual patient.Syftet var att undersöka patienters uppfattning av information given vid utskrivning från en urologisk vårdavdelning på Akademiska sjukhuset samt att undersöka om patienterna själva sökt information efter utskrivningen. Studien är en empirisk tvärsnittstudie med deskriptiv design. Alla patienter inskrivna som urologpatienter, som skrevs ut till hemmet från en urologisk vårdavdelning under mars månad 2009 tillfrågades att delta (sammanlagt 82 patienter), 57 patienter deltog. Som datainsamlingsmetod användes en telefonintervju med 20 strukturerade frågor. Frågorna skickades hem till patienterna efter hemgång och författarna ringde sedan upp patienterna i hemmet och genomförde intervjun. De områden som kirurgiska patienter upplever störst bekymmer för efter utskrivning från sjukhuset är sårvård, smärthantering, daglig aktivitet, att upptäcka komplikationer, symtomhantering, elimination och livskvalitet. Studien visar att 72 % av deltagarna tyckte att den information de fått var tillräcklig för att sköta sin egenvård. Den information som saknats har varit inom områdena daglig aktivitet, eventuella komplikationer som kan uppstå och smärtlindring. Majoriteten av utskrivningssamtalen ägde rum på patientsalen. Postoperativa komplikationer som uppträder efter utskrivning kan bli kostsamma för samhället och är källa till onödigt lidande för patienten, patienten behöver därför förstå vad denne skall vara uppmärksam på efter hemgång. Detta ställer krav på både läkare och sjuksköterskor att ge information som är relevant för varje individuell patient.
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Auren, Karlgren Birgitta. "Från intensivvård till vårdavdelning : En systematisk litteraturstudie ur ett patientperspektiv." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap, HV, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-17863.
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Inledning: Patienter som varit svårt sjuka och vårdats på intensivvårdsavdelning, upplever ofta oro och ångest, när de ska överflyttas till vårdavdelning. Dessa patienter har stort vårdbehov, eftersom flertalet inte återhämtat sig, från sitt svåra sjukdoms tillstånd. Patienterna är fortfarande mycket trötta, har nedsatt muskelkraft och svårt att klara sig själva. Målet med studien är, att med kunskap om hur patienter upplever överflyttningen, försöka finna former för hur vi ska kunna underlätta denna för patienten. Syftet med studien är att beskriva patienters upplevelser i samband med överflyttning från intensivvårdsavdelningen till vårdavdelningen. Metoden var systematisk litteraturstudie av vetenskapliga artiklar. Materialet granskades med kvalitativ innehållsanalys. Resultatet visar att flertalet patienter upplever överflyttningen positivt och de tolkar den, som att de blivit bättre. Ett antal patienter upplever överflyttningen med omedvetna känslor, antingen har de minnesluckor, eller ser de överflyttningen som en normal händelse i vårdkedjan. Ett fåtal patienter upplever överflyttningen som mycket traumatisk, de drabbas av oro och ångest, sk”flyttstress”. De oroar sig över hur de ska klara sig på vårdavdelning, känner sig enormt hjälplösa och har en rädsla över att bli ”glömda” på sitt rum och inte få den hjälp, de anser att de behöver. Slutsatsen av litteratur studien är att ett fåtal patienter upplever stor oro och ångest, när de ska lämna intensivvårdsavdelningen (IVA). Det är de patienter som varit svårast sjuka, oftast med multiorgansvikt och en lång vårdtid på IVA. Det är dessa patienter vi måste hjälpa till bättre livskvalitet vid en överflyttning till vårdavdelning. Förslagsvis utarbetas ett samarbete mellan mottagande vårdavdelning och intensivvårdsavdelning. Information upplever patienterna, som enormt viktig. En väl informerad patient är också en trygg patient. Anhöriga görs mer delaktiga i vården och är de välinformerade blir de ett stort stöd för patienten.
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Mangolds, Virginia B. "Health Literacy, Care Transition and Adherence with Discharge Instructions of Patients Discharged to Home from the Emergency Department." eScholarship@UMMS, 2018. https://escholarship.umassmed.edu/gsn_diss/54.
Full textAbstract:
Purpose: The purpose of this study is to describe the relationship between health literacy, preparedness for discharge, adherence to discharge instructions and difficulty coping after discharge among emergency department patients.
Specific Aims: The Aims of this study were to: (1) describe the variability of health literacy of adult patients in an academic tertiary Emergency Department; (2) describe the relationship between health literacy, care transition, and perceived readiness for discharge on the patient’s adherence to discharge instructions and (3) explore whether health literacy, perceived preparation for discharge and care transition, predicts difficulty coping after discharge.
Framework: Dr. Meleis’s Transitions Theory was used as a framework.
Design: This is a prospective cohort study of adults treated and discharged from the ED. Results: Eighty five percent of the subjects completed the study (n = 132). Subjects satisfied with transition care (P = .025) and who felt more prepared for discharge (P = .035) had less difficulty coping. Subjects more satisfied with care transition were more likely to adhere to medication instructions (P = .029). The higher the satisfaction with discharge preparation, the less likely the subjects were to go to their follow-up appointment (P = 0.051). No associations were found with health literacy.
Conclusion: Satisfaction with care transition during the discharge process and feeling well-prepared are related to less difficulty coping after discharge. Nurses have an opportunity to intervene and enhance the discharge experience. This may contribute to more positive outcomes after being seen in an emergency department.
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Pangallo, Georgianne. "Effect of a supportive and informational telephone call on threat appraisal in the newly discharged surgical cardiac patient." Virtual Press, 1990. http://liblink.bsu.edu/uhtbin/catkey/722461.
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The purpose of the present study was to test the theoretical relationship of the concepts of informational support and threat appraisal with a sample of surgical cardiac patients twenty-four hours after discharge from the hospital. These discharged patients were adjusting to the transition of hospital to home environment while still recovering from a life threatening illness. They may need varying informational supports to reduce their threat perception of the magnitude of the illness. A convenience sample of thirty-six surgical cardiac patients was assigned to three groups. The groups received the standard discharge preparation as stated by the hospitals' policy and procedure manual. The experimental group received a supportive and informational telephone call approximately twenty-four hours after discharge. The second group was the placebo group, these participants were given a telephone call at the end of the twenty-four hours to remind them to return the questionnaire. The third group was the control group, received no telephone call and were instructed to complete the questionnaire at the specified time. All groups were instructed at the time of initial contact to complete the questionnaire at approximately the end of the first twenty-four hours after discharge. The placebo group and control group were then pooled for data analysis due to the low return rate of the two groups. The two groups were compared with a t-test. The demographic data compared age and educational level to the perceived level of threat. Reliability of the tool was determined using a Cronbach's Alpha.School of Nursing
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Almborg, Ann-Helene. "Perceived Participation in Discharge Planning and Health Related Quality of Life after Stroke." Doctoral thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ, Institutet för gerontologi, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-1223.
Full textAbstract:
The overall aim of this thesis was to investigate the patients’ and their relatives’ perceived participation in discharge planning after stroke and the patients’ health-related quality of life, depressive symptoms, performance of personal daily activities and social activities in connection with discharge. Another aim was to evaluate the psychometric assumptions of the SF-36 for Swedish stroke patients. Prospective, descriptive and cross-sectional designs were used to study all patients with stroke admitted to the stroke unit at a hospital in southern Sweden from October 1, 2003 to November 30, 2005 each with one close relative. The total sample consisted of 188 patients (mean age=74.0 years) and 152 relatives (mean age=60.1 years). Data were collected during interviews, 2-3 weeks after discharge. The results showed that less depressive symptoms, more outdoor activities and performance of interests are important variables that related to higher HRQoL. SF-36 functions well as a measure of health related quality of life in Swedish stroke patients, but the two summary scales have shortcomings. Compared to a Swedish normal population, scores on all scales/components of the SF-36 were lower among stroke patients especially in the middle-aged group. Most of the patients perceived that they received information, but fewer perceived participation in the planning of medical treatment and needs of care/service/rehabilitation and goal setting. The relatives perceived that they need more information and they perceived low participation in goal setting and needs assessment. The professionals seem to lack effective practices for involving patients and their relatives to perceive participation in discharge planning. It is essential to develop and to implement methods for discharge planning, including sharing information, needs assessment with goal setting that facilitate patients’ and relatives’ perceived participation. The results suggest that ICF can be used in goal setting and needs assessment in discharge planning after acute stroke.